Provider Demographics
NPI:1609864313
Name:WEIS, WILLIAM M JR (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:WEIS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9 WILPERT RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-4604
Mailing Address - Country:US
Mailing Address - Phone:732-764-0382
Mailing Address - Fax:
Practice Address - Street 1:314 US HIGHWAY 22
Practice Address - Street 2:SUITE I
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1700
Practice Address - Country:US
Practice Address - Phone:732-752-4646
Practice Address - Fax:732-752-7804
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00112800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ462159Medicare UPIN